EUS-FNA is superior to ERCP-based tissue sampling in suspected malignant biliary obstruction: results of a prospective, single-blind, comparative study

Gastrointest Endosc. 2014 Jul;80(1):97-104. doi: 10.1016/j.gie.2013.12.031. Epub 2014 Feb 19.


Background: Both EUS and ERCP sampling techniques may provide tissue diagnoses in suspected malignant biliary obstruction. However, there are scant data comparing these 2 methods.

Objective: To compare EUS-guided FNA (EUS-FNA) and ERCP tissue sampling for the diagnosis of malignant biliary obstruction.

Design: Prospective, comparative, single-blind study.

Setting: Tertiary center.

Patients: Fifty-one patients undergoing same-session EUS and ERCP for the evaluation of malignant biliary obstruction over a 1-year period.

Interventions: EUS-FNA and ERCP tissue sampling with biliary brush cytology and intraductal forceps biopsies.

Main outcome measurements: Diagnostic sensitivity and accuracy of each sampling method compared with final diagnoses.

Results: EUS-FNA was more sensitive and accurate than ERCP tissue sampling (P < .0001) in 51 patients with pancreatic cancers (n = 34), bile duct cancers (n = 14), and benign biliary strictures (n = 3). The overall sensitivity and accuracy were 94% and 94% for EUS-FNA, and 50% and 53% for ERCP sampling, respectively. EUS-FNA was superior to ERCP tissue sampling for pancreatic masses (sensitivity, 100% vs 38%; P < .0001) and seemed comparable for biliary masses (79% sensitivity for both) and indeterminate strictures (sensitivity, 80% vs 67%).

Limitations: Single-center study.

Conclusion: EUS-FNA is superior to ERCP tissue sampling in evaluating suspected malignant biliary obstruction, particularly for pancreatic masses. EUS-FNA appears similar to ERCP sampling for biliary tumors and indeterminate strictures. Given the superior performance characteristics of EUS-FNA and the higher incidence of pancreatic cancer compared with cholangiocarcinoma, EUS-FNA should be performed before ERCP in all patients with suspected malignant biliary obstruction. (

Clinical trial registration number: NCT01356030.).

Publication types

  • Clinical Trial
  • Comparative Study
  • Video-Audio Media

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / complications
  • Bile Duct Neoplasms / diagnosis*
  • Bile Ducts, Intrahepatic* / diagnostic imaging
  • Bile Ducts, Intrahepatic* / pathology
  • Cholangiocarcinoma / complications
  • Cholangiocarcinoma / diagnosis*
  • Cholangiopancreatography, Endoscopic Retrograde*
  • Cholestasis / etiology*
  • Endoscopic Ultrasound-Guided Fine Needle Aspiration*
  • Female
  • Gallbladder Neoplasms / complications
  • Gallbladder Neoplasms / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatitis / complications
  • Pancreatitis / diagnosis
  • Prospective Studies
  • Sensitivity and Specificity
  • Single-Blind Method

Associated data